Chapter 4 - Orchestrating Change
This chapter describes the BSFT approach to orchestrating change in
the family. The first section describes how BSFT counselors establish
a therapeutic relationship, including the importance of joining with
the family, the role of tracking family interactions, and what is
involved in building a treatment plan. The second section describes
strategies for producing change in the family, including focusing on
the present, reframing negativity in the family, shifting patterns of
interaction through reversals of usual behavior, changing family
boundaries and alliances, "detriangulating" family members caught in
the middle of others' conflicts, and opening up closed family systems
or subsystems by directing new interactions.
Establishing a Therapeutic Relationship
The counselor's first step in working with a family is to establish a therapeutic relationship with the family, beginning with the very first contact
with family members. The quality of the relationship between the
counselor and the family is a strong predictor of whether families will
come to, stay in, and improve in treatment (Robbins et al. 1998). In
general, studies have found that the therapeutic relationship is a strong
predictor of success in many forms of therapy (Rector et al. 1999; Stiles
et al. 1998). Validating and supporting the family as a system and
attending to each individual family member's experience are particularly
important aspects of developing and maintaining a good therapeutic
relationship (Diamond et al. 1999; Diamond and Liddle 1996).
Establishing a therapeutic relationship means that the BSFT counselor
needs to form a new system--a therapeutic system--made up of the
counselor and the family. In this therapeutic system, the counselor is
both a member and its leader. One challenge for the BSFT counselor
is to establish relationships with all family members, some of whom
are likely to be in conflict with each other. For example, drug-abusing
adolescents generally begin treatment in conflict with their parent(s)
or guardian(s). Both parties approach counseling needing support
from the counselor. The counselor's job is to find ways to support the
individuals on either side of the conflict. For example, the counselor
might say to the adolescent, "I am here to help you explain to your something he or she would like to achieve, the counselor is able to establish a therapeutic alliance with the whole family.
The BSFT approach is based on the view that building a good therapeutic
relationship is necessary to bring about change in the family.
Several strategies for building a therapeutic relationship, joining,
tracking, and building a treatment plan, are discussed below.
A number of techniques can be used to establish a therapeutic relationship.
Some of these techniques fall into the category of "joining,"
or becoming a temporary member of the family.
Definition of Joining
In BSFT, joining has two aspects. Joining it is the steps a counselor
takes to prepare the family for change. Joining also occurs when a
therapist gains a position of leadership within the family. Counselors
use a number of techniques to prepare the family to accept therapy
and to accept the therapist as a leader of change. Some techniques
that the therapist can use to facilitate the family's readiness for
therapy include presenting oneself as an ally, appealing to family
members with the greatest dominance over the family unit, and
attempting to fit in with the family by adopting the family's manner of
speaking and behaving. A counselor has joined a family when he or
she has been accepted as a "special temporary member" of the family
for the purpose of treatment. Joining occurs when the therapist has
gained the family's trust and has blended with family members. To
prepare the family for change and earn a position of leadership, the
counselor must show respect and support for each family member
and, in turn, earn each one's trust.
One of the most useful strategies a counselor can employ in joining
is to support the existing family power structure. The BSFT counselor
supports those family members who are in power by showing
respect for them. This is done because they are the ones with the
power to accept the counselor into the family; they have the power
to place the counselor in a leadership role, and they have the power
to take the family out of counseling. In most families, the most powerful
member needs to agree to a change in the family, including
changing himself or herself. For that reason, the counselor's strongest
alliance must initially be with the most powerful family member. BSFT
counselors must be careful not to defy those in power too early in the
process of establishing a therapeutic relationship. Inexperienced family
counselors often take the side of one family member against another,
behaving as though one were right and the other were obviously
wrong. In establishing relationships with the family, the counselor must
join all family members, not just those with whom he or she agrees.
In fact, frequently, the person with whom it is most critical to establish
an alliance or bond is the most powerful and unlikable family member.
Many counselors in the drug abuse field feel somewhat hopeless
about helping the families of drug-abusing youths because these families have many serious problems. Counselors who feel this way
may find a discussion about becoming a member of the family
unhelpful because their previous efforts to change families have been
unsuccessful. BSFT teaches counselors how to succeed by approaching
families as insiders, not as outsiders. As outsiders, counselors typically
attempt to force change on the family, often through confrontation.
However, the counselor who has learned how to become part of the
system and to work with families from the inside should seldom need
to be confrontational. Confrontation erodes the rapport and trust that
the counselor has worked hard to earn. Confrontation can change the
family's perception of the counselor as being an integral part of the
therapeutic system to being an outsider.
The Price of Failed Joining
An example may help illustrate what is meant by powerful family
members. The court system referred a family to counseling because
its oldest child had behavior problems. The mother was willing to
come to counseling with her son, but the mother's live-in boyfriend
did not want the family to be in counseling. The counselor advised
the mother to come to therapy with the adolescent anyway. The
boyfriend felt that his position of power had been threatened by the
potential alliance between the mother and the counselor. As a result,
the boyfriend reasserted himself, demanding that she stop participating
in counseling. She then dropped out of counseling. This is clearly a case in which the counselor's early challenge of the family's way of "operating" caused the entire family to drop out of treatment. The counselor could and should have been more aware and respectful of the family's existing power structure. Respect, in this case, does not mean that the counselor approves of or agrees with the boyfriend's behavior. Rather, it means that the counselor understands
how this family is organized and works his or her way into the family through the existing structure.
A more adaptive counseling strategy might be to call the mother's
boyfriend, with the mother's permission, to recognize his position of
power in the family and request his help with his girlfriend's son.
A Cautionary Note: Family Secrets
As was already stated, joining is about establishing a relationship with
every member of the family. Sometimes a family member will try to
sabotage the joining process by using family secrets. Some secrets
can cause the counselor such serious problems that he or she is
forced to refer the family he or she had intended to help to another
counselor. Secrets are best dealt with up front. The counselor should
not allow himself or herself to get trapped in a special relationship
with one family member that is based on sharing a secret that the
other family members do not know. A counselor who keeps a secret
is caught between family members. The counselor has formed an
alliance with one family member to the exclusion of others. In some
cases, it is not just an alliance with one family member but also an alliance with one family member against another family member. It
means that the family member with the secret can blackmail the
counselor with the threat of revealing that the counselor knows this
secret and didn't address it with the family. Consequently, a family
secret is a very effective strategy that family members can use to
sabotage the treatment, if counselors let them.
For these reasons, counselors should make it a rule to announce to
each family at the onset of counseling that he or she will not keep
secrets. The counselor should also say that if anyone shares special
information with the counselor, the counselor will help them share it
with the appropriate people in the family. For example, if a wife calls
and tells the counselor that she is having an affair, her spouse will need
to know, although the children do not need to know the parents' marital
issues. In this case, the counselor would say, "This affair is indicative
of a problem in your marriage. Let me help you share it with your
husband." The counselor must do whatever is needed to continue to
help the wife see that affairs are symptoms of marital problems. The
affair can be reframed as a cry for help, a call for action, or a basic discontent. If so, these marital issues or problems need to be discussed.
It is possible that despite all the counselor's efforts, the wife will
respond with an absolute, "No, I don't want to tell him. He would leave
me. Besides, this affair doesn't mean all that much." Typically BSFT
therapy only gets into marital issues to the extent that the marital problems
are interfering with the parents' abilities to function effectively as
parents. However, the counselor has no choice but to help the wife tell
her husband about the affair. If the wife absolutely refuses, then the
counselor has lost his or her bid for leadership in the counseling
process. The wife now has control over the counseling process. For that
reason, the counselor must refer the family to another counselor.
In the example on p. 27 about the mother's powerful boyfriend, it
was recommended that the counselor use the way in which the family
is organized, or interacts, with the father figure in a position of
power, as a vehicle for getting the family into treatment. This strategy
in which the counselor learns how the family interacts and then uses
this information to establish a therapeutic plan of action is called
"tracking." Tracking is a technique in which the counselor respects
how the family interacts but, at the same time, takes advantage of
those family interactions for therapeutic purposes. Sometimes families
interact spontaneously, permitting the counselor to observe the family
dynamics. When this does not happen spontaneously, the counselor
must encourage the family to interact.
Encouraging the Family to Interact
When a family is in counseling, family members like to tell the counselor
stories about each other. For example, a mother might say to
the counselor, "My son did so and so." In contrast to the way in
which the counselor functions in other therapy models, the BSFT counselor is not interested in the content of the family members' stories.
Instead, the counselor is interested in observing (and correcting) problematic
interactions. To observe the family's patterns of interaction, the
counselor must ask family members to talk directly to each other
about the problem. When this occurs, the counselor can observe
or track what happens when the family members discuss the issue.
The counselor can then watch the family's interactions: fighting, disagreeing,
and struggling with their issues. By tracking, the counselor
will not only be able to identify the interactive patterns in the family,
but also will be able to determine which of these patterns may be
causing the family's problems or symptoms. The added benefit of this
kind of tracking is that the counselor shows respect for the family's
ways of interacting.
Tracking Content and Process
The difference between "content" and "process" was discussed in
Chapter 2 (see p. 13). Content is the subject matter that is being
discussed. Process refers to the interactions that underlie the communication.
By observing the process, the counselor learns who is dominant,
who is submissive, what emotions are expressed in the interaction, and
the unwritten rules that appear to guide the family's communication
and organization. For example, a mother may mention that her son's
drug problem is a concern. The grandmother responds by shouting
that the mother is overreacting and needs to back off. The content of
the interaction--the son's drug problem--is not nearly as important as
the process being displayed--the grandmother undermining the
mother and shutting her down. Often the counselor will track or use
the family's content because it represents a topic that is important to
the family. In this example, the counselor might keep the focus of the
counseling session on the son's drug problem because it is an important
topic in this family. However, the focus of BSFT is entirely on
changing process. What needs to be changed here, as a first step, is
the parent figures' inability to agree on the existence of a problem,
and, more generally, the grandmother's tendency to invalidate the
"Mimesis" is a form of tracking for the purpose of joining. It refers to
mimicking the family's behavior in an effort to join with the family.
Mimesis can be used to join with the whole family. For example, a
counselor can act jovial with a jovial family. Mimesis also can be used
to join with one family member. Mimesis is used in everyday social
situations. For example, by attending to how others dress for a particular
activity so that one can dress appropriately, one is attempting
to gain and demonstrate acceptance by mimicking the type of dress
that is worn by others (e.g., casual). People mimic other people's
moods when they act like the other people do in certain situations.
For example, at a funeral they would act sad as others do and at a
celebration they would act joyful. When the counselor validates a family
by mimicking its behavior, family members are more likely to
accept the counselor as one of their own.
Mimesis also refers to using a family's own ways of speaking to join
with the family. Each family and each family member has its, his, or
her own vocabulary and perspective. For instance, if a family member
is a carpenter, it might be useful to use the language of carpentry.
The therapist might say, "Dealing with your son requires lots of
different tools, just like jobs at work do. Sometimes you need to use
a hammer and use a lot of force, and sometimes you need to use a
soft cloth for a more gentle job." If a family member is an accountant,
it may be helpful to speak in terms of assets and liabilities. If a person
is religious, it may be helpful to speak of God's will.
Whatever language a family uses should be the language the counselor
uses to converse with that family. The counselor should not talk to a
family using vocabulary that is found in this manual--words such as
"interactions," "restructuring," and "systems." Instead, the BSFT counselor
should use the "pots and pans" language that each of the family
members uses in his or her everyday life. For example, if families are
uncomfortable with the term "counseling," the term "meetings" might
Much of the work the counselor does to establish the therapeutic
relationship involves learning how the family interacts to better blend
with the family. However, the counselor cannot learn the ways in
which the family interacts unless he or she sees family members
interacting as they would when the counselor is not present. Getting
family members to interact can be difficult because families often
come into counseling thinking that their job is to tell the counselor
what happened. Therefore, it is essential that counselors decentralize
themselves by discouraging communications that are directed at
them, and instead encouraging family members to interact so that
they can be observed behaving in their usual way.
Building a Treatment Plan
BSFT diagnoses are made to identify adaptive and maladaptive patterns of family interaction so that the counselor can plan practical, strategically
efficient interventions. The purpose of the intervention is to improve
the family interactions most closely linked to the adolescent's symptoms.
This, in turn, will help the family to manage those symptoms.
Enactment: Identifying Maladaptive Interactions
In BSFT, the counselor assesses and diagnoses the family's interactions
by allowing the family to interact in the counseling session as it normally
does at home. To begin, the counselor asks the family to discuss
something. When a family member speaks to the counselor about
another family member who is present, the counselor asks the family
member who is speaking to repeat what was said directly to the
family member about whom it was said. Family interactions that occur
as they would at home and that show the family's typical interactional
patterns are called "enactments." An enactment can either occur spontaneously,
or the counselor can initiate it by asking family members to
discuss something among themselves. Creating enactments of family interactions is like placing the counselor on the viewing side of a oneway
mirror and letting the family "do its thing" while the counselor
Different therapy models have different explanations for why a family
or adolescent is having difficulty, and so they have different targets
of intervention. BSFT targets interactional patterns. Because BSFT is
a problem-focused therapy approach, it targets those interactional
patterns that are most directly related to the symptom for which the
family is seeking treatment. Targeting patterns most directly related to
the symptom allows BSFT to be brief and strengthens a therapist's
relationship with a family by demonstrating that the therapist will help
the family solve the problems family members have identified.
Families that develop symptoms tend to be organized or to function
around those symptoms. That's because a symptom works like a
magnet, organizing the family around it. This is especially true if the
symptom is a serious, life-threatening one, such as drug abuse.
Therefore, it is most efficient to work with the family by focusing on
the symptom around which the family has already organized itself.
Family Crises as Enactments
Enactments are used to observe family interactions in the present and
to identify family interactional problems. Family crises are particularly
opportune types of enactments because they are highly charged,
and family members are emotionally available to try new behaviors.
Therefore, families in crisis should be seen immediately. In addition
to gaining valuable information about problematic family interactions,
the counselor gains considerable rapport with families because
he or she is willing to be of service at a time of great need.
A Cautionary Note: Adolescents Attending Therapy Sessions on Drugs
Counselors usually refuse to work with a client who comes into the
therapy session on drugs because the client is viewed as "not being
all there" to do the treatment work. However, in the case of a family
therapy such as BSFT, determining whether to conduct the session is
a strategic decision the counselor must make. One possibility in BSFT
is to view the adolescent on drugs as an enactment of what the family
confronts at home all the time. Thus, when an adolescent comes to
therapy on drugs, it can be viewed as an opportunity for the counselor
to teach the family how to respond to the adolescent when he or she
takes drugs. The BSFT counselor can see how each family member
responds to this situation and look for the maladaptive interactions
that allow the adolescent to continue this behavior. The counselor can
then work with the non-drug-using family members to change their
usual way of responding to the adolescent on drugs. Hence, the work
in this session is not with the adolescent but with the other family
From Diagnosis to Planning
Once a therapeutic relationship has been established and a diagnosis
has been formulated, the counselor is ready to develop a treatment
plan. The treatment plan lays out the interventions that will be necessary
to change those family maladaptive interactional patterns that
have been identified as related to the presenting symptom.
Problematic patterns of family interaction are diagnosed using the six
dimensions of family interaction discussed in Chapter 3 (organization,
resonance, developmental stages, life context, identified patient, and
conflict resolution). Often some dimensions are more problematic
than others. The interventions need to focus more on the most problematic
interactions than on the others.
The six dimensions of the family's interactions operate in an interdependent
fashion. For this reason, it may not be necessary to plan a separate intervention to address each problem that has been diagnosed. For example, addressing a family's tendency to blame its problems on the adolescent (i.e., the identified patient) may bring the family's ineffective conflict resolution strategies to light. In a similar fashion, addressing a son's role as his mother's confidant (i.e., inappropriate developmental stage) may bring out the rigid and inflexible boundary between the parent figures.
As was stated earlier, the focus of BSFT is to shift the family from maladaptive patterns of interaction to adaptive ones. Counselors can use
a number of techniques to facilitate this shift. These techniques, all of
which are used to encourage family members to behave differently,
fall under the heading of "restructuring." In restructuring, the counselor
orchestrates and directs change in the family's patterns of interaction
(i.e., structure). Some of the most frequently used restructuring
techniques are described in this chapter.
When the family's structure has been shifted from maladaptive
toward adaptive, the family develops a mastery of communication
and management skills. In turn, this mastery will help them solve
both present and future problems. To help family members master
these skills, the BSFT counselor works with them to develop new
behaviors and use these new behaviors to interact more constructively
with one another. After these more adaptive behaviors and
interactions occur, the BSFT counselor validates them with positive
reinforcements. Subsequently, the counselor gives the family the task
of practicing these new behaviors/interactions in naturally occurring
situations (e.g., when setting a curfew or when eating meals together)
so that family members can practice mastering these skills at home.
Mastering more adaptive interactions provides families with the tools
they need to manage the adolescent's drug abuse and related problem
behaviors. Some adaptive behaviors/interactions that validate individual family members are self-reinforcing. However, the counselor needs to
reinforce those behaviors/interactions that initially are not strongly
self-reinforcing (i.e., validated) to better ensure their sustainability. As
family members reinforce each other's more adaptive skills, they master
the skills needed to behave in adaptive ways. It is very important to
note that mastery of adaptive skills is not achieved by criticizing,
interpreting, or belittling the individual. Rather, it is achieved by
incrementally shaping positive behavior.
The rest of this chapter describes seven frequently used restructuring
techniques (i.e., to change families' patterns of interaction). These techniques
will give a counselor the basic tools needed to help a family
change its patterns of interaction. The seven restructuring techniques are:
- Working in the present
- Reframing negativity
- Working with boundaries and alliances
- Opening up closed systems
Working in the Present
Although some types of counseling focus on the past (Bergin and
Garfield 1994), BSFT focuses strictly on the present. In BSFT, families
do not simply talk about their problems, because talking about problems
usually involves telling a story about the past. Working in the
present with family interactional processes that are maintaining the
family's symptoms is necessary to bring about change in BSFT.
Consequently, the BSFT counselor wants the family to engage in
interactions within the therapy session--in the same way that it
would at home. When this happens and family members enact the
way in which they interact routinely, the counselor can respond to
help the family members reshape their behavior. Several techniques
that require working in the present with family processes are found
in subsequent sections within this chapter.
Does BSFT Ever Work in the Past?
Counselors work with the past less than 5 percent of the counseling
time. One important example of working in the past can be illustrated
by an early counseling session in which the parent and adolescent
are in adversarial roles. The parent may be angry or deeply hurt by
the youth's behavior. One strategy to overcome this impasse in which
neither family member is willing to bend is to ask the parent, "Can
you remember when Felix was born? How did you feel?" The parent
may say nostalgically: "He was such a beautiful child. The minute I
saw him, I was enchanted. I loved him so much I thought my heart
This kind of intervention is called "reconnection" (cf. Liddle 1994,
1995, 2000). When the parent is hardened by the very difficult experiences
he or she has had with a troublesome adolescent, counselors
sometimes use the strategy of reconnection to overcome the impasse
in which neither the parent nor the youth is willing to bend first.
Reconnection is an intervention that helps the parent recall the positive
feeling (love) that he or she once had for the child. After the parent
expresses his or her early love for the child, the counselor turns to
the youth and says: "Did you know your mother loves you so very
much? Look at the expression of bliss on her face."
As can be seen, the counseling session digressed into the past for a
very short time to reconnect the parent. This was necessary to change
the here-and-now interaction between two family members. The
reconnection allowed the counselor to transform an interaction characterized
by resentment into an interaction characterized by affection.
Because the feelings of affection and bonding do not last long, the
counselor must move quickly to use reconnection as a bridge that
moves the counseling to a more positive interactional terrain.
Reframing: Systemic Cognitive Restructuring
To "reframe," a counselor creates a different perspective or "frame" of
reality than the one within which the family has been operating. He
or she presents this new frame to the family in a convincing manner
--that is, "selling" it to the family and then using this new frame
to facilitate change. The purpose of systems-oriented, cognitive
restructuring (reframing) is to change perceptions and/or meaning in
ways that will enable family members to change their interactions.
Most of the time, in families of adolescent drug abusers, negativity
needs to be reframed. Negativity is usually exhibited as blaming,
pejorative, and invalidating statements ("You are no good." "I can't
trust you."), and, in general, "angry fighting." Reframing negativity
might involve describing a mother's criticism of her teenage son as
her desire that he be successful, or reframing fighting as an attempt
to have some sort of connection with another family member.
It has been suggested that "... high levels of negativity interfere with
effective problem-solving and communication within the family"
(Robbins et al. 1998, p. 174). Robbins and colleagues report that negativity
in family therapy sessions is linked to dropping out of family
therapy. For those who remain in therapy, negativity is linked to poor
family therapy outcomes. Because negativity is bad for the family and
for the therapy, most contemporary family therapies target negativity
(Alexander et al. 1994). The best-known strategy for transforming negative
interactions into positive ones is reframing (Robbins et al. 2000).
While the counselor is encouraged to permit family members to interact
with each other in their usual way and to join before orchestrating
change, a caveat is necessary when intense negative feelings accompany
conflictive interactions. If the family is to remain in counseling,
family members must experience some relief from the negative feelings
soon after counseling begins. Therefore, counselors are encouraged to use reframing abundantly, if necessary, in the first and perhaps the
first few sessions to alleviate the family's intensive negative feelings.
Such reframes also may allow family members to discuss their pain
and grievances in a meaningful way.
An example will help illustrate the use of reframing negative feelings
to create more positive feelings among family members. Anger is a
fairly common emotion among families with an adolescent who is
involved in antisocial activities. The parents may feel angry that their
attempts to guide their child down the "right" path have failed and that
the child disrespects their guidance. The adolescent is likely to interpret
this anger as uncaring and rejecting. Both parties may feel that the
other is an adversary, which severely diminishes the possibility that
they can have a genuine dialogue.
The particular reframe that needs to be used is one that changes the
emotions from anger, hurt, and fighting (negative) to caring and concern
(positive). The counselor must create a more positive reality or
frame. The counselor, for example, might say to the parent, "I can see
how terribly worried you are about your son. I know you care an
awful lot about him, and that is why you are so frustrated about what
he is doing to himself."
With this intervention, the counselor helps move both the parent's
and the child's perceptions from anger to concern. Typically, most
parents would respond by saying, "I am very worried. I want my
child to do well and to be successful in life." When the youth hears
the parent's concern, he or she may begin to feel less rejected.
Instead of rejecting, the parent is now communicating concern, care,
and support for the child. Hence, by creating a more positive sense of
reality, the counselor transforms an adversarial relationship between
the parent(s) and the adolescent, orchestrating opportunities for new
channels of communication to emerge and for new interactions to take
place between them.
Reframing is among the safest interventions in BSFT, and, consequently,
the beginning counselor is encouraged to use it abundantly.
Reframing is an intervention that usually does not cause the counselor
any loss of rapport. For that reason, the counselor should feel
free to use it abundantly, particularly in the most explosive situations.
Affect: Creating Opportunities for New Ways of Behaving
In BSFT, counselors are interested in affect (a feeling or an emotion)
as it is reflected in interactions. In BSFT, the counseling strategy is to
use emotion as an opportunity to "move" the family to a new, more
adaptive set of interactions. One of many possible ways of working
with emotion is found in the following example. When a mother
cries, the counselor might suggest to the drug-abusing youngster,
"Ask your mom to tell you about her tears." An alternative would be,
"What do you think your mom's tears are trying to say?" If the youth
responds, "I think it is...," the counselor would follow with a directive to the youth, "Ask your mother if what you think her tears mean is
why she is crying." In this way, the crying is used to initiate an interaction
among family members that acknowledges not only the emotion
in crying but also the experience underlying the crying. In other
words, the crying is used to promote interactions that show respect
for the emotion as well as promote a deeper level of understanding
among family members.
In another example, a drug-abusing adolescent and her family come
to their first BSFT counseling session. The parents proceed to
describe their daughter as disobedient, rebellious, and disrespectful--
a girl who is ruining her life and going nowhere. They are angry and
reject this young girl, and they blame her for all the pain in the family.
In this instance, the BSFT counselor recognizes that the family is
"stuck" about what to do with this girl and that their inability to
decide what to do is based on the view they have developed about
her and her behavior. To "open up" the family to try new ways to
reach the youngster, the BSFT counselor must present a new "frame"
or perspective that will enable the family to react differently toward
the girl. The BSFT counselor might tell the family that, although she
realizes how frustrated and exasperated they must feel about their
daughter's behavior, "it is my professional opinion that the main
problem with this girl is that she is very depressed and is in a lot of
pain that she does not know how to handle." Reframing is a practical
tool used to stimulate a change in family interactions. With this new
frame, the family may now be able to behave in new ways toward
the adolescent, which can include communicating in a caring and
nurturing manner. A more collaborative set of relationships within the
family will make it easier for the parents to discuss the daughter's
drug abuse, to address the issues that may be driving her to abuse
drugs, and to develop a family strategy to help the adolescent reduce
her drug use.
When using the technique called "reversal," the counselor changes a
habitual pattern of interacting by coaching one member of the family
to do or say the opposite of what he or she usually would. Reversing
the established interactional pattern breaks up previously rigid patterns
of interacting that give rise to and maintain symptoms, while
allowing alternatives to emerge. If an adolescent gets angry because
her father nagged her, she yells at her father, and the father and
daughter begin to fight, a reversal would entail coaching the father to
respond differently to his daughter by saying, "Rachel, I love you
when you get angry like that," or "Rachel, I get very frightened when
you get angry like that." Reversals make family members interact
differently than they did when the family got into trouble.
Working With Boundaries and AlliancesCertain alliances are likely to be adaptive. For example, when the authority or parent figures in the family are allied with each other, they will be in a better position to manage the adolescent's problem behaviors. However, when an alliance forms between a parent figure and one of the children against another parent figure, the family is likely to experience trouble, especially with antisocial adolescent
behavior. An adolescent who is allied with an authority figure has a
great deal of power and authority within the family system.
Therefore, it would be difficult to place limits on this adolescent's
problem behavior. One goal of BSFT is to realign maladaptive
One important determinant of alliances between family members is
the psychological barrier between them, or the metaphorical fence
that distinguishes one member from another. BSFT counselors
call this barrier or fence a "boundary." Counselors aim to have
clear boundaries between family members so that there is some
privacy and some independence from other family members.
However, these should not be rigid boundaries, with which family
members would have few shared experiences. By shifting boundaries,
BSFT counselors change maladaptive alliances across the generations
(e.g., between parent figures and child). For example, in a family in
which the mother and the daughter are allied and support each other
on almost all issues while excluding the father, the mother may no
longer be powerful enough to control her daughter when she
becomes an adolescent and may need help. In this case, an alliance
between the mother and the father needs to be re-established, while
the cross-generational coalition between mother and daughter needs
to be eliminated.
It is the BSFT counselor's job to shift the alliances that exist in the
family. This means restoring the balance of power to the parents or
parent figures so that they can effectively exercise their leadership in
the family and control their daughter's behavior. The counselor
attempts to achieve these alliance shifts in a very smooth, subtle, and
perhaps even sly fashion. Rather than directly confronting the alliance
of the mother and daughter, for example, the counselor may begin
by encouraging the father to establish some form of interaction with
Boundary shifting is accomplished in two ways. Some boundaries
need to be loosened, while others need to be strengthened.
Loosening boundaries brings disengaged family members (e.g., father
and daughter) closer together. This may involve finding areas of common
interest between them and encouraging them to pursue these
interests together. For instance, in the case of a teenaged son
enmeshed with his mother and disengaged from his father, the counselor
may direct the father to involve his son in a project or to take
his son on regular outings. The counselor also may arrange the seating
in counseling sessions to help strengthen some alliances and loosen
In addition to bringing family members closer together, the counselor
may need to strengthen the boundaries between enmeshed family
members to create more separation. One example is the mothergrandmother
parenting system in which the grandmother enables her grandson's drug use by protecting him from his mother's attempts to set limits. Rather than confronting the grandmother-adolescent alliance directly, the counselor may first encourage the mother and grandmother to sit down together and design a set of rules and
responsibilities for the adolescent. This process of designing rules
often requires the parent figures to work out some of the unresolved
conflict(s) in their relationship, without the counselor having to
address that relationship directly. This brings the mother closer to the
grandmother and distances the grandmother from the adolescent,
thereby rearranging the family's maladaptive hierarchy and subsystem
It should be noted that, in this case, the counselor tracks the family's
content (grandmother hiding adolescent's drug use from mother) as
a maneuver to change the nature of the interaction between the
mother and the grandmother from an adversarial relationship to one in
which they agree on something. The adolescent's drug use provides
the content necessary to strengthen the boundaries between the
generations and to loosen the boundaries between the parent figures.
Clearly, bringing the mother and grandmother together to the negotiating
table is only an intermediate step. After that, the tough work
of helping mother and grandmother negotiate their deep-seated
resentments and grievances against each other begins. Because the
counselor follows a problem-focused approach, he or she does not
attempt to resolve all of the problems the parent figures encounter.
Instead, the counselor tries to resolve only those aspects of their
difficulties with each other that interfere with their ability to resolve
the problems they have with the adolescent in the family.
Behavioral Contracting as a Strategy for Setting Limits for Both Parent and Adolescent
From a process perspective, setting clear rules and consequences
helps develop the demarcation of boundaries between parent(s) and
child(ren). Sometimes when a parent and an adolescent have a very
intense conflictive relationship in which there is a constant battle over
the violation of rules, the rules and their consequences are vague,
and there is considerable lack of consistency in their application. In
these cases, it is recommended that the counselor use behavioral
contracting to help the parent(s) and the adolescent agree on a set of
rules and the resulting consequences if he or she fails to follow these
rules. The counselor encourages the parent(s) and the adolescent to
negotiate a set of clearly stated and enforceable rules, and encourages
both parties to commit to maintaining and following these rules.
Helping parents use behavioral contracting to establish boundaries
for themselves in relationship to their adolescent is of tremendous
therapeutic value. Parents who have established boundaries can no
longer respond to the adolescent's behavior/misbehavior according
to how they feel at the time (lax, tired, frustrated, angry). The parents
have committed themselves to respond according to agreed-upon rules. From a BSFT point of view, it is very important for the counselor
to begin to help the parents develop adequate boundaries with
their adolescent children who have behavior problems.
In families that have problems with boundaries, the counselor's most
difficult task is to get the parents to stick to their part of the contract.
Counselors expect that the adolescent will not keep his or her part of
the contract and instead will try to test whether his or her parents will
try to stick to their part of the contract. When the adolescent misbehaves,
parents tend to behave in their usual way, which may be a reaction
to the way they feel at the moment. The counselor's job is to make
the parents uphold their side of the agreement. Once parents have set
effective boundaries with their adolescent children, most misbehavior
quickly diminishes. (Of course, sometimes rules and consequences
need to be renegotiated as parents and adolescents begin to acquire
experience with the notion of enforceable rules and consequences.)
Boundaries Between the Family and the Outside World
It is important not only to understand the nature of the alliances and
boundaries that occur within the family but also to understand the
boundaries that exist between the family and the outside world. (See
Chapter 3, p. 21 on life context.)
Some families have very rigid boundaries around themselves, prohibiting
their members from interacting with the outside world. Other
families have very weak boundaries around themselves that allow
outsiders to have an undue influence on family members. Either of
these extremes can be problematic and is fair ground for BSFT intervention.
For example, if parents are uninvolved with their children's
school or friends (rigid boundaries), the BSFT counselor works to get
the parents to participate more fully in their child's school life and to
interact more with their child's friends.
As was said earlier, triangles occur when a third, usually less powerful,
person gets involved in a conflict between two others. It is a basic
assumption of BSFT that the only way conflict between two people
(called a "dyad") can be resolved is by keeping the conflict between
them. Bringing in a third person and forming a triangle becomes an
obstacle to resolving the conflict. The third person usually is drawn
into a coalition with one of the parties in conflict and against the
other. This coalition results in an imbalance within the original dyad.
The issues involved in the conflict are detoured through the third
person rather than dealt with directly. For example, when parent
A has a fight with parent B, parent B may attack the adolescent in
retaliation for parent A's behavior (or attempt to enlist the youth's
support for his or her side of the argument) rather than expressing
his or her anger directly to parent A. Such triangulated adolescents
are often blamed for the family's problems, and they may become
identified patients and develop symptoms such as drug abuse.
Because triangulation prevents the involved parties from resolving
their conflicts, the goal of counseling is to break up the triangle.
Detriangulation permits the parents in conflict to discuss issues and
feelings directly and more effectively. Detriangulation also frees the
third party, the adolescent, from being used as the escape valve for
the parents' problems.
One of the ways in which a BSFT counselor achieves detriangulation
is by keeping the third party (i.e., the adolescent) from participating
in the discussions between the dyad. Another way to set boundaries
to detriangulate is to ask the third party not to attend a therapy session
so that the two conflicting parties can work on their issues directly.
For example, when working with a family in which the son begins to
act disrespectfully whenever his parents begin to argue, the counselor
might instruct the parents to ignore the son and continue their
discussion. If the son's misbehavior becomes unmanageable, the
counselor may ask the son to leave the room so that the parents can
argue without the son's interference. Eventually, the counselor will
ask the parents to collaborate in controlling the son.
Attempts by the Family to Triangulate the Counselor
Triangulation does not necessarily have to involve only family members.
Sometimes a counselor can become part of a triangle as well.
One of the most common strategies used by family members is to
attempt to get the counselor to ally himself or herself with one family
member against another. For example, one family member might say
to the counselor, "Isn't it true that I am right and he is wrong?" "You
know best, you tell him." "We were having this argument last night,
and I told her that you had said that...."
Triangulation is always a form of conflict avoidance. Regardless of
whether it is the counselor or a family member who is being triangulated,
triangulation prevents two family members in conflict from
reaching a resolution. The only way two family members can resolve
their conflicts is on a one-to-one basis.
An important reason why the counselor does not want to be triangulated
is that the person in the middle of a triangle is either rendered
powerless or symptomatic. In the case of the counselor, the "symptom"
he or she would develop would be ineffectiveness as a therapist, that
is an inability to do his or her job well because his or her freedom of
movement (e.g., changing alliances, choosing whom to address, etc.)
has been restricted. A triangulated counselor is defeated. If the counselor
is unable to get out of the triangle, he or she has no hope of
being effective, regardless of what else he or she does or says.
When a family member attempts to triangulate the counselor, the
counselor has to bring the conflict back to the people who are
involved in it. For example, the counselor might say, "Ultimately, it
doesn't matter what I think. What matters is what the two of you
agree to, together. I am here to help you talk, negotiate, hear each
other clearly, and come to an agreement." In this way, the counselor
places the focus of the interaction back on the family. The counselor
also might respond, "I understand how difficult this is for you, but
this is your son, and you have to come to terms with each other, not
Opening Up Closed Systems
Families in which conflicts are not openly expressed need help in
discussing the conflict so that it can be a target for change. Sometimes
a counselor can work with a family member who has an unexpressed
or implicit conflict and help that person discuss the problem so
that it can be resolved. This brings conflicts out into the open and
facilitates their resolution by intensifying and focusing on covert emotional
issues. In families of drug-abusing adolescents, a typical example
of unexpressed or suppressed conflict involves disengaged fathers
who tend to deny or avoid any discussion of the youth's problems.
Asking a surly or sulking adolescent to express what is on his or her
mind whenever the father is addressed may help the father break
through his denial.
The use of "tasks" or assignments is central to all work with families.
The counselor uses tasks both inside and outside the counseling
sessions as the basic tool for orchestrating change. Because the
emphasis in BSFT is in promoting new skills among family members,
at both the level of individual behaviors and in family interactional
relations, tasks serve as the vehicle through which counselors choreograph
opportunities for the family to behave differently.
In the example in which mother and son were initially allied and the
father was left outside of this alliance, father and son were first
assigned the task of doing something together that would interest them
both. Later on, the mother and father were assigned the collaborative
task of working together to define rules regarding the types of behaviors
they would permit in their son and the consequences that they
would assign to their son's behavior and misbehavior.
It is a general rule that the BSFT counselor must first assign a task for
the family to perform in the therapy session so that the counselor has
an opportunity to observe and help the family successfully carry out
the task. Only after a task has been accomplished successfully in the
therapy session can a similar followup task be assigned to the family
to be completed outside of therapy.
Moreover, the counselor's aim is to provide the family with a successful
experience. Thus, the counselor should try to assign tasks that
are sufficiently doable at each step of the counseling process. The
counselor should start with easy tasks and work up to more difficult ones, slowly building a foundation of successes with the family
before attempting truly difficult restructuring moves.
Hope for the Best; Be Prepared for the Worst
Counselors should never expect the family to accomplish the
assigned tasks flawlessly. In fact, if family members were skillful
enough to accomplish all assigned tasks successfully, they would not
need to be in counseling. When tasks are assigned, counselors
should always hope for the best but be prepared for the worst. After
all, a task represents a new way of behaving for the family and one that
may be difficult given that they have had years of practice engaging
in the old ways of behaving.
As the family attempts to carry out a task, the counselor should help
the family overcome obstacles it may encounter. However, in spite of
the counselor's best efforts, the task is not always accomplished. The
counselor's job is to observe and/or uncover what happened and
identify the obstacles that prevented the family from achieving the
task. When a task fails, the counselor starts over and works to overcome
the newly identified obstacles. Unsuccessful attempts to complete
tasks are a great source of new and important information regarding the
interactions that prevent a family from functioning optimally.
The first task that family counselors give to all of their cases is to bring
everyone into the counseling session. Every counselor who works with
problem youths and their families knows very well that most of the
families who need counseling never reach the first counseling session.
Therefore, these families can be described as having failed the first task
given them, to come in for counseling. This task, called engagement,
is so important that we have devoted the next chapter to it.